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Appraisal or revalidation

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... appear for the first time before fitness to practise panels operated by the ... 7) Re-certification will rely on membership of the relevant medical Royal College ... – PowerPoint PPT presentation

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Title: Appraisal or revalidation


1
Appraisal or revalidation?
2
Appraisal revalidation?
  • By the end of this session I will
  • Have revised, undestood and therefore be better
    prepared for my part in the current appraisal
    process
  • Be more aware of the current political climate
    regarding doctors regulation
  • Better undestand the proposals about
    re-validation
  • Have reponded, in part, to proposals contained in
    Liam Donaldson's "Good doctors, Safer patients"
    paper

3
GP Appraisal
  • Good clinical care
  • Maintaining good medical practice
  • Relationships with patients
  • Working with colleagues
  • Teaching and training
  • Probity
  • Management activity
  • Research
  • Health

4
Good clinical care
  • What would you include? What do you think are
    the main strengths and weaknesses of your
    clinical practice? How has the clinical care you
    provide improved since your last appraisal
    ? What do you think are your clinical care
    development needs? What factors in your
    workplace(s), or more widely, constrain you
    significantly in achieving what you aim for in
    your clinical work

5
Appraisal
  • In pairs, spend some time looking at one of the
    areas of GP appraisal What would you put
    in? How are you going to collect this
    information? Feed this back to the group

6
Good clinical care
  • Examples of documentation you might refer to and
    supply
  • up-to-date audit data (as appropriate)
    prescribing analyses (if applicable)
  • PCT clinical governance reviews (as appropriate)
    relevant clinical guidelines you use
  • records of any significant event audits or
    critical incident reports
  • any complaints and records of their investigation
  • any reflective diary you keep about these events
  • any plaudits you have received
  • any in-house or personal monitoring materials
    you use
  • references or feedback from colleagues

7
(No Transcript)
8
Revalidation background
  • The Shipman Inquiry Fifth Report (2004)

Review of medical regulation (Sec of State for
Health)
Call for Ideas /collection of GMC National
Clinical Assessment Service (NCAS)
data/high-level advisory group
The Donaldson Report - Good doctors, safer
patients (July 06)
Time of consultation and feedback via BMA and
colleges
9
Revalidation background
  • Under performance in medical workforce has 5
    five year prevalence in research studies.
  • Three other major inquiries (Ayling, Neale,
    Kerr/Haslam) showed
  • disjointed and inadequate system of complaints
    handling
  • ineffective communications
  • silent local healthcare community
  • absence of checks on clinical competence

10
Revalidation background
  • Doctors incidence of drug dependence (USA) is
    estimated at 12 and when alcohol abuse is
    considered, this figure increases to 1014.
  • The number of complaints lodged with GMC in 2005
    gt double that for 1996
  • 1,700 doctors were referred between 2001 and 2005

11
Revalidation background
  • Each year, approximately 300 doctors appear for
    the first time before fitness to practise panels
    operated by the General Medical Council.
  • 650 doctors are referred to the NCAS each year
    http//www.ncas.npsa.nhs.uk
  • one-year risk of referral is approximately 0.5
    for all doctors and rises to 1 for those in the
    most senior posts

12
Revalidation background
  • concerns about behaviour are at least as common
    as concerns about clinical capability.
  • 67 re. BEHAVIOUR
  • 61 re. COMPETENCE
  • Referral rates 1120 DOCTORS
  • (NCAS report)
  • Behaviour ? revaledgecumbe.ppt

13
Revalidation background (Behavioural themes 1)
  • A highly motivated population who demand too much
    of themselves and others
  • Diligence that becomes obsessionalism
  • Confidence that becomes arrogance (narcissism)
  • Denial of responsibility for own actions
  • Creativity - perceived as maverick behaviour

14
Revalidation background (Behavioural themes 2)
  • Overly compliant (becoming overwhelmed)
  • Feelings of victimisation and alienation
  • Loss of power and control leading to depression,
    lowered self-esteem, and more entrenched
    behaviour
  • Poor insight into impact of behaviour

15
Revalidation background (Behavioural themes 3)
16
Revalidation background
  • No country has a code of practice linked to a
    mechanism of re-licensure or re-certification
  • Good medical practice is not yet quantified
    sufficiently to permit its use for revalidation
  • BUT
  • 9/10 members of the public and more than 7/10
    doctors thought it important that doctors
    competence was assessed every few years (MORI
    pole)

17
Revalidation structure
  • Devolution of the regulatory function from the
    GMC into local organisations
  • Creation of local GMC affiliates
  • Employed by each organisation providing
    healthcare
  • Act as local regulators decision-makers and would
    also oversee remediation

18
Possible revalidation tools
  • (OSCE)
  • multi-source feedback (MSF)
  • direct observation of procedural skills (DOPS)
  • clinical evaluation exercises (mini-CEX)
  • case-based discussions
  • routine data collected in the NHS
  • complaints (source of customer feedback)
  • Monitoring mortality rates

19
Voting proposals
  • 1) Balance of probabilities/beyond all reasonable
    doubt (civil vs. criminal)
  • 2) GMCs role in investigating extended to local
    level (medically qualified licensed GMC
    affiliates) with formal adjudication by a
    separate and independent tribunal
  • 3) Where complaint too serious this will be
    investigated and assessed by GMC but adjudication
    by independent tribunal

20
Voting proposals
  • 4) Appraisal should be changed to 360 involving
    feedback from medical other professional
    colleagues managers and patients with
    comparisons against generic standards contained
    in contract
  • 5) Measure of professional standards to be
    embedded within the appraisal process and set by
    the relevant medical college with input from
    patients

21
Voting proposals
  • 6) Revalidation all doctors renew their license
    annually but in addition
  • general practice and specialist registers will
    require re-certification every five years
  • 7) Re-certification will rely on membership of
    the relevant medical Royal College
  • 8) Significant events,prescribing information and
    death monitoring part of quality assurance
  • 9) PCTs should be guaranteed unfettered access to
    all patient records

22
Voting proposals
  • 10) If patient switches registered doctor without
    changing their address is offered a confidential
    interview with PCT
  • 11) As doctors approach retirement registrant and
    affiliate consider whether further five-year
    period of re-licensure is OK
  • 12)PMETB to take over the curriculum setting
    inspection and approval of medical schools

23
Voting proposals
  • 13)Student registration with the GMC an
    affiliate from med school staff assess fitness of
    students to practice
  • 14)After each locum appointment ends contracting
    organisation providebrief standardised return to
    the relevant GMC affiliate on performance and any
    concerns
  • 15) GMC members no longer elected but
    independently appointed by the Public
    Appointments Commission President to be elected
    from amongst membership

24
Voting proposals
  • 16)cost of medical regulation doubling 77.7M
    155.9M
  • extras cost 18.9M DOH
  • 41.3M NHS
  • 18M Doctors

25
Revalidation…..
Or
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